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Background: It is not clear if diabetes reduces systolic left ventricular function (LVEF) irrespective of coronary artery disease (CAD). The aim was to compare LVEF between diabetic and non-diabetic patients with respect to the extent of CAD.Methods and results: Consecutive patients undergoing stress myocardial perfusion SPECT (MPS) were evaluated. MPS was interpreted using a 20 segment model with a 5-point-scale to define summed stress (SSS), rest (SRS) and difference score (SDS). LVEF was measured by gated SPECT, and then compared with respect to diabetic status and SSS categories. Of 2635 patients data of 2400 was available. Of these, 24% were diabetic; mean age was 64±11y; 31% were female. Diabetics had a significantly lower LVEF compared to non-diabetics: 53±13% and 55±13%, respectively (p = 0.001). Diabetics had a lower LVEF compared to non-diabetics regardless of CAD extent. Diabetics and non-diabetics did not differ significantly in the distribution of SSS categories. Diabetes was an independent predictor of decreased LVEF (OR 1.6 95% CI 1.2 - 2.0; p < 0.001).Conclusion: Diabetics had a lower LVEF than non-diabetics. This difference could be demonstrated regardless of CAD extent and might in part explain their generally worse cardiac survival compared to non-diabetic patients on an epidemiological level. In addition, this finding points to other discussed mechanisms than CAD lowering LVEF in diabetic patients.